Dr. Vikas Singla
Acute pancreatitis is a sudden inflammation of the pancreas, a gland in the upper abdomen responsible for digestion and blood sugar regulation. The condition is primarily caused by gallbladder stones and alcohol consumption, requiring prompt medical attention and specialized care.
The primary causes of acute pancreatitis are gallbladder stones and excessive alcohol consumption. Gallbladder stone-related pancreatitis is more common in middle-aged women, as stones can slip into the bile duct, which shares an opening with the pancreatic duct, leading to obstruction and inflammation. Alcohol-induced pancreatitis is more prevalent in men, typically after prolonged heavy drinking of over 100 grams of alcohol daily for five years or more.
However, genetic factors also influence susceptibility. Other less common causes include elevated calcium and triglyceride levels, excessive vitamin D intake, parathyroid hormone imbalance, pancreatic tumors, trauma (especially in children), certain medications, viral infections like mumps, and parasitic infections such as ascaris worms.
The primary symptom of acute pancreatitis is severe abdominal pain, often radiating to the back and alleviated by leaning forward or lying in a prone position. Patients may also experience nausea, vomiting, constipation, and reduced gas passage. In severe cases, breathing difficulties and decreased urine output can occur, indicating complications. If the condition is caused by bile duct obstruction or pancreatic tumors, jaundice may also be present.
Acute pancreatitis is diagnosed through a combination of clinical symptoms, blood tests, and imaging studies. Elevated levels of pancreatic enzymes (amylase and lipase) in blood tests confirm the diagnosis, while additional tests assess liver and kidney function, blood counts, and blood gas levels. Imaging techniques such as ultrasound and CT scans help detect pancreatic swelling and gallstones, with endoscopic ultrasound (EUS) used if gallstones are suspected but not visible on ultrasound.
Treatment primarily involves hospitalization and supportive care, with severe cases requiring intensive care. Key management strategies include intravenous fluids for hydration and blood pressure maintenance, pain relief through appropriate medications, oxygen therapy for respiratory distress, and nutritional support. In mild cases, oral intake resumes as symptoms improve, while severe cases may require tube feeding. Addressing the underlying cause, such as gallstones or alcohol consumption, is crucial to prevent recurrence.
In the first week of acute pancreatitis, complications may involve multiple organ failure, affecting the lungs, kidneys, and heart. From the second week onward, fluid leakage from the pancreas can lead to the formation of pseudocysts or Walled-Off Pancreatic Necrosis (WOPN), which may require drainage through endoscopic ultrasound (EUS) or percutaneous catheter placement if infected. Long-term management focuses on preventing recurrence by addressing the underlying cause.
For gallstone-related pancreatitis, gallbladder removal surgery is performed before discharge if the condition is mild, while severe cases require stabilization before surgery. In alcoholic pancreatitis, complete abstinence from alcohol is essential. Other causes, such as high calcium or triglyceride levels, certain medications, and pancreatic tumors, must be managed appropriately to prevent future episodes.
Some patients may develop diabetes mellitus due to insulin deficiency or experience digestive issues (fatty diarrhea) due to enzyme insufficiency. Without proper treatment of the underlying cause, there is a risk of recurrent attacks.
Acute pancreatitis is a serious condition requiring expert medical management. With timely intervention and proper treatment, most patients achieve favorable outcomes. Prevention through lifestyle modifications, early detection, and appropriate medical care is essential in reducing recurrence risks.
(The author is Senior Director & Head – Gastroenterology, Max Super Specialty Hospital, Saket.)
